One of Dennis Jenkins' books on the shuttle may be able to help. I do recognize the manuevering pods on the wings and tails, the RMS stored in a hump on the spine, and the OMS pods faired into the payload bay doors. But what specific model, and who built it, I don't know.

sev8n

That looks like one of the Phase B design studies, probably most closely resembling MSC-040C.